Return-to-Sports Rates After Anterior Cruciate Ligament Reconstruction with High-Grade Impaction Fracture of the Posterolateral Tibial Plateau.

Background

High-grade fracture of the posterolateral tibial plateau (PLTP) has been reported to increase bone loss, which in turn is associated with residual rotational instability and impaired function after anterior cruciate ligament (ACL) reconstruction.

Purpose

To investigate whether high-grade impaction fracture in PLTP is associated with the rate of return to sports (RTS) after ACL reconstruction (ACLR).

Study design

Cohort study; Level of evidence, 3.

Methods

This study retrospectively analyzed data from patients with complete ACL tears between December 2018 and June 2022. Inclusion criteria included primary ACLR with autologous hamstring reconstruction, standard preoperative magnetic resonance imaging (MRI) evaluation, and at least 2 years of postoperative follow-up. In contrast to bone contusions, a high-grade impaction fracture in PLTP is defined as subchondral or cortical bone displacement in this area involving the articular surface. Based on whether or not there were high-grade impaction fractures seen on the preoperative MRI, patients were divided into 2 groups: high-grade fracture and control group. Patients were followed up after surgery to assess their level of RTS, Tegner score, Lysholm score, and recovery time. The chi-square test was used to compare the differences in the RTS rate between the 2 groups.

Results

Among 190 patients, 34 patients (17.9%) were in the high-grade group, while 156 patients (82.1%) were in the control group. Among the main outcomes, the high-grade fracture knee group performed worse in return to any sport (Tegner score ≥5) (71% vs 88.9%; P = .002) and level 1/2 (cutting) sports (26.5% vs 46.2%; P = .035), while there was no significant difference in return to strenuous sports (Tegner score ≥6) (48.4% in the high-grade group and 62.7% in the control group; P = .136) and return to play (2.9% in the high-grade group and 10.3% in the control group; P = .317). In the later follow-up period of survival analysis, the rate of recovery of any sport was slower in the high-grade fracture group (hazard ratio, 0.22; 95% CI, 0.07-0.72; P = .0118).

Conclusion

The results of this study showed that high-grade impaction fracture of PLTP was associated with the rate of RTS after ACLR, mainly in the rate of return to any sport and level 1/2 (cutting) sports. Accordingly, the rehabilitation strategies and priorities for such patients should be adjusted to compensate for the impact.